Drug utilization 90%: an innovative method in assessing quality of drug prescription with specific reference to non-steroidal anti-inflammatory drugs prescription

Dhananjay, Kulkarni; Kokila, B N; Sahu, Santosh Kumar; Kumar, Gyan R

doi:10.18203/2319-2003.ijbcp20162893

Cited by 4 publications

(6 citation statements)

References 15 publications

(20 reference statements)

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“…Proposed in the 1990s, DU90% is a simple index-an innovative tool by the time-used in drug utilization researches as a quality indicator of prescribing practices in healthcare institutions or beyond. By ranking the volume of drugs utilized as computed and compiled in terms of standardized measurement unit DDD, DU90% identifies the list of drugs accounting for 90% of the total drug consumption [35,42]. Generally speaking, the shorter the list of the drug products and the most, if not all, of them being based on the official (institutional) clinical guidelines constituting the DU90%, the better the quality of prescribing practices [43].…”

Section: Plos Onementioning

confidence: 99%

Trends of community-based systemic antibiotic consumption: Comparative analyses of data from Ethiopia and Norway calls for public health policy actions

2021

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Studies on antibiotic utilization trends are invaluable because they offer data for evaluation of impacts of antimicrobial stewardship policies. Such studies help determine correlations between the use of specific antibiotic classes and trends in emergence of resistance (resistance-epidemiology). This study aims to quantify the consumption systemic antibiotics (J01)—in defined daily doses (DDD) per 1000 inhabitants per day (DID)—in Ethiopia’s public healthcare sector (2016–2020). By so doing, it attempts to capture the extent of population exposure to antibiotics in the country. Data were also compared with those from Norway to establish rough estimate of the country’s status vis-à-vis some globally acknowledged better practices with regard to optimal use of antibiotics. Raw data obtained from registers of Ethiopian Pharmaceutical Supply Agency were converted into DDD, per the standard methodology recommended by WHO. To control for population size, antibiotics consumption data were presented as DID. Since official population census data for Ethiopia were not available for the study period, population projection data from the World Bank were used. Community-based consumption of systemic antibiotics increased from 11.02 DID in 2016 to 12.83 DID in 2020 in Ethiopia—an increase by 16.4%. Moreover, analysis of a log-linear regression model showed that the average growth rate in the community-based systemic antibiotics consumption per year between 2016 and 2020 was about 3.3% (R2 = 0.89). The highest percentage change in community-based systemic antibiotics consumption happened for glycopeptides (J01XA) and the fourth generation cephalosporins (J01DE)—1300% and 600% compared to the baseline year (2016), respectively. At product level, 9 antibiotics constituted the common domain in the list of medication cocktails in the drug utilization 90% (DU90%) for the study period. Community-based consumption of systemic antibiotics for Ethiopia and Norway showed opposite trends, calling for public health policy actions in Ethiopia.

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Section: Plos Onementioning

confidence: 99%

Trends of community-based systemic antibiotic consumption: Comparative analyses of data from Ethiopia and Norway calls for public health policy actions

2021

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“…Unique medicines were identified using the first nine digits of the British National Formulary (BNF) code, which identifies each chemical substance. In line with previous studies which excluded products without a WHO Defined Daily Dose,[3, 15, 18] certain non-oral pharmaceutical products were excluded before analysis based on their BNF codes (see eTable 1). Medicines were arranged in descending order of total number of prescriptions for each medicine within a practice and the DU90% calculated represents the number of medicines where the cumulative sum of prescriptions is >90% of all prescriptions issued by the practice.…”

Section: Methodsmentioning

confidence: 99%

“…Similarly, a segment with limited number of drugs may indicate more rational prescribing. [15] Wettermark et al assessed the usefulness of DU90% as a tool for indicating prescribing quality, and found high acceptance of this among GPs in Sweden who regarded DU90% profile as clear, relevant and useful for improving prescribing quality. [16]…”

Section: Introductionmentioning

confidence: 99%

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.

Chiedozie

Murphy

Fahey

et al. 2020

Preprint

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Aim: To apply the DU90% indicator (the number of unique drugs which make up 90% of a doctor's prescribing) to GP practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics Method: This is an observational cohort study of all general practices in England. It utilises publicly available prescribing data from the National Health Service (NHS) Digital platform for 2013-2017. The DU90% was calculated on an annual basis for each practice based on medication BNF codes. Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multi-level linear regression was used to examine the practice characteristics (relating to staff, patients, and deprivation of the practice area). Results: A total of 7,623 GP practices were included. The mean DU90% ranged from 130.1 to 133.4 across study years, and variation between practices was low (with a 1.4 fold difference between the lowest and highest 5% of practices). A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are female or aged 65+, higher number of GPs working in the practice, and being in a more deprived area were associated with a higher DU90%. Conclusion: GP practices typically use 130 different medications in the bulk of their prescribing. Increasing use of personal formularies may enhance prescribing quality and reduce costs.

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“…Similarly, a segment with limited number of drugs may indicate more rational prescribing. 15 Wettermark et al assessed the usefulness of DU90% as a tool for indicating prescribing quality, and found high acceptance of this among GPs in Sweden who regarded DU90% profile as clear, relevant and useful for improving prescribing quality. 16 The aims of this study are: ► To characterise the DU90% indicator in prescribing data from GP practices in England, by assessing time trends, variation between practices and relationship with practice characteristics.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England

Chiedozie¹,

Murphy²,

Fahey³

et al. 2021

BMJ Open

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AimTo apply the drug utilisation 90% (DU90%) indicator (the number of unique drugs which makes up 90% of a doctor’s prescribing) to general practitioner (GP) practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics, prescribing costs and low-value prescribing.Study designRetrospective cohort study.SettingPrimary care in England, using publicly available prescribing data available from the National Health Service (NHS) digital platform for 2013–2017.ParticipantsAll general practices in England (n=7620).Primary and secondary outcome measuresThe DU90% was calculated on an annual basis for each practice based on medication British National Formulary codes. Low-value prescribing was defined using NHS 2017 guidance (including lidocaine plasters, liothyronine, omega-3 supplements). Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multilevel linear regression was used to examine the practice characteristics (relating to staff, patients and deprivation of the practice area).ResultsAmong 7620 practices, mean DU90% ranged from 130.0 to 131.0 across study years, and regarding variation between practices, there was a 1.4-fold difference between the lowest and highest 5% of practices. A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are women or aged ≥45 years, higher number of GPs working in the practice and being in a more deprived area were associated with a higher DU90%. Practices in higher quintiles of DU90% had higher levels of low-priority prescribing and prescribing costs.ConclusionGP practices typically use 130 different medications in the bulk of their prescribing. Higher DU90% was associated with higher levels of low-priority prescribing and prescribing costs. Increasing use of personal formularies may enhance prescribing quality and reduce costs.

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Drug utilization 90%: an innovative method in assessing quality of drug prescription with specific reference to non-steroidal anti-inflammatory drugs prescription

Cited by 4 publications

References 15 publications

Trends of community-based systemic antibiotic consumption: Comparative analyses of data from Ethiopia and Norway calls for public health policy actions

Trends of community-based systemic antibiotic consumption: Comparative analyses of data from Ethiopia and Norway calls for public health policy actions

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.

How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England

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